Unhealthy obsession with total cholesterol reduction is thwarting CVD prevention

“The medical world is only interested in statins and lowering cholesterol. Statins might lower cholesterol but in doing so, they cause inflammation, a biochemical trigger in the development of CVD, high blood pressure, cancer, HIV, diabetes type 2 and Alzheimer’s,”​ Dr Ioannis Zabetakis, lecturer on food lipids at the University of Limerick’s Department of Life Sciences, told NutraIngredients. 

Instead of statins, Dr Zabetakis advocated personalised nutritional intervention based on the Mediterranean diet pyramid, with the aim of increasing ‘good’ HDL cholesterol and reducing inflammation through consumption of foods like fish, olive oil, fruit, vegetables and nuts. 

“The problem isn’t caused by having high serum cholesterol. It doesn’t matter what your cholesterol levels are as long as you have anti-inflammatory foods in your diet. Once you stop inflammation it is like constructing a huge wall against a plethora of diseases,”​ he said. 

A hole in the sterol argument?​

But in championing dietary intervention, Dr Zabetakis is not endorsing cholesterol-lowering plant sterol spreads, which he puts in the same basket as statins. 

“Plant sterol spreads are based on the same philosophy and functionality as statins in that they are aimed at reducing cholesterol,” ​he said.

Dr Zabetakis made these comments in the context of the study presented by the Italian Neuromed Institute at last week’s European Society of Cardiology congress.

The Italian scientists linked the Mediterranean diet with lower mortality rates for sufferers of cardiovascular disease, findings that were welcomed by Dr Zabetakis.

“This research brings more data to support our view that it is high time for nutritionists and food scientists to join forces and say no to statins.​

"There is evidence in both animals and humans to suggest that dietary intervention can be as effective as statins, because specific components in foods like fish and dairy can inhibit inflammation.”​

Challenging the cholesterol-CVD link​

Dr Zabetakis has also led studies in this area, with the latest published in Food & Function​ in April.

This stemmed from an inconsistency in the association between serum cholesterol and CVD that was established in the ‘Seven Countries Study’.

While the study found a link between serum cholesterol and CVD in US and Northern European countries, it found the link was weak in Southern European and Japanese populations. 

Dr Zabetakis and his colleagues identified a need to revisit the evidence and review the relative importance of cholesterol versus other lipids as potential modulators of atherogenesis, a condition whereby arteries become clogged with fatty substances.

In this latest review, they assessed the merits of statin therapy in CVD versus dietary interventions that impact on lipids other than cholesterol, including omega-3 fatty acids and polar lipid fractions of foods such as fish and olive oil. 

They concluded that “careful design around the lipid components of dietary interventions presents a credible alternative in patients who are intolerant to statins or averse to taking such drugs”​.